Back Pain and Osteoporosis
Tuesday, September 25, 2012 - Noon (EST)
Cleveland_Clinic_Florida_Host: Today's Live Web Chat, "Back Pain and Osteoporosis" with John O'Connell, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.
Cleveland_Clinic_Florida_Host: Thank you for joining us for the live web chat on Back Pain and Osteoporosis. We will be starting very shortly, please begin to submit your questions and the doctor will answer them in the order they are received.
Teresana: I had a discectomy 9 months ago but still feel discomfort when exercising. Which are the best kinds of workouts I should be doing at this stage?
Dr_O_Connell: What level did you have the discectomy at? What kind of exercise are you doing? Typically, jarring exercise such as treadmill or running may incite more pain then elliptical or swimming. Also, what kind of discomfort are you experiencing?
JDsportsgirl: Are facet block medications similar to epidural steroid injections and do those have any effect on yearly IV bisphosphonate medication?
Dr_O_Connell: Facet injections are targeted to the joints in the back of the spine as opposed to epidurals which are targeted at the nerve space. They treat different kinds of pain. They're not likely to affect your medication if done judiciously.
toralmehta: Our father is 86 years of age and had a spinal fusion surgery in February 2012, he is a kidney transplant patient, diabetic, hence we had questions about his condition, What can we try for pain control which is not oral medicine? Injections? Epidural? What would they suggest? He is currently taking Teriparatide, Calcium and Vitamin D for bone fusion. Also, is there any benefit to trying fusion stimulator like Spinal-Stim? Could this type of treatment hurt a transplant kidney?
Dr_O_Connell: Hopefully he's exercising regularly; even a small bit really helps. Spinal stimulators are a great way to treat pain but require surgery to install. Epidurals and other interventional techniques are a great way to treat pain with minimal side effects
toralmehta: What should we investigate to find out the root of the problem? Why is our father still in pain?
Dr_O_Connell: It's not uncommon to still have pain at this point; also, there are likely other structures that could be contributing to his pain that were not addressed by the surgery. He should be re-evaluated by his doctor.
toralmehta: What type of structures are you talking about?
Dr_O_Connell: Examples include the joints such as facets and sacroiliac as well as the hip joints, all frequent pain generators. He should see a spine specialist who will examine him and order studies as indicated. Ideally he is also doing back exercises.
toralmehta: Due to his age can back exercises be safe for him?
Dr_O_Connell: Absolutely, I have just about all of my patients exercise. The type and intensity varies from individual to individual but everyone should exercise.
toralmehta: Would osteoporosis slow down the healing of the spinal fusion surgery or is the recovery longer?
Dr_O_Connell:Osteoporosis can prolong recovery, it is not likely to make stenosis worse but does increase the risk of a fracture whether he had surgery or not.
toralmehta: What do we do for pain management post lumbar fusion surgery?
Dr_O_Connell: Typically medications, injections and therapy.
toralmehta: What kind of tests would you recommend to be repeated after a lumbar fusion surgery?
Dr_O_Connell: That depends on the patient's symptoms and physical examination findings.
Dr_O_Connell: The doctor may want to repeat X-rays to assess the fusion. MRI typically is not indicated unless there are problems.
toralmehta: But then how would we find out about the other structures such as facets and sacroiliac being impacted? Would the X-ray show that too?
Dr_O_Connell: No, imaging studies do little to tell us where pain comes from. A thorough examination is more likely to elicit pain generators.
toralmehta: What medications increase bone density loss?
Dr_O_Connell: Teriparatide may increase bone density.
Dr_O_Connell: Some of the worse things for bone density are smoking and soda.
darcy: I was diagnosed with spondylolisthesis and I have been seen by a neurologist and several spine doctors. I am still in constant, daily pain and it getting progressively worse. I’m taking Neurontin and Ultram, doing PT and occasional acupuncture treatments (Old fx L5-S1) detected on MRI. What can I do?
Dr_O_Connell: You should be doing exercise to keep your core strong, interventional procedures can relieve pain adjunctive to exercise, if you are not able to participate. If you're not doing an exercise program, it's great to start with a physical therapist.
CurlyLou: I have L5-S1 grade 2 spondylolisthesis, what happens if the vertebra slips to grade 3 or higher, should I consider surgery then?
Dr_O_Connell: I'd recommend keeping a close eye on that, monitor symptoms and keep regular follow up with your doctor to assess progress.
Teresana: I had a discectomy on left L4-5. Diagnosis:HNP L4-5 - Doing yoga, swimming and dancing which most of the time lead to lower back pain. Is this something that would eventually go away? I used to have numbness on my entire left leg, but no more after surgery.
Dr_O_Connell: The back pain should be easing up. Yoga is a great form of exercise. It may be possible that something else is causing pain such as a joint in the back. Also, even with discectomy, the other discs may be painful and all the pain may not go away. It’s rare that all pain is related to one disc only, usually the joints and other discs may be involved.
jayshree: What kind of exercises are recommended for spinal fusion surgery patients?
Dr_O_Connell: Exercises that condition the core musculature are always indicated, planks can be done with minimal motion but as everyone is individual, it's best to be evaluated by your doctor to see what is safe for you. Also, it's important to keep the hip girdle muscles flexible to allow the spine to move.
Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with John O'Connell, who is taking your questions about Back Pain and Osteoporosis. To ask a question, type in the box below and then click 'Ask'
jpr: Hello Dr. O’Connell, does Glucosamine Chondroitin really help?
Dr_O_Connell: Some people do very well with it, it's safe so I often recommend giving it a try for at least two months, stopping if it doesn't help. It’s kind of slow acting so people often don't notice it until they stop.
ShawnaK: My 67 year old father has a herniated disk and stenosis when do you recommend he get assessed for surgery and what is the best treatment option for him?
Dr_O_Connell: The best treatment depends on how bad his symptoms are. If he's well controlled, exercise and medication is sufficient. Injections can be added as needed, if all else fails or he's getting worse surgery is considered.
rebekah: What are artificial discs? Are they effective, I’m considering.
Dr_O_Connell: Implantable devices that go between the bones of the spine and preserve their motion. The indication is very narrow but patients often do well.
Teresana: Is Naproxen a good pain relief medication for back pain? Is it safe to take on a regular basis?
Dr_O_Connell: Naproxen is a great medication for pain. I do not recommend people take it every day as it can irritate the stomach and even affect the kidneys and blood pressure if taken chronically. It is best to use occasionally.
help_my_back: What is the best treatment(s) available to treat / relieve symptoms related to Caudad Equina syndrome?
Dr_O_Connell: Cauda Equina syndrome is typically treated surgically.
Teresana: What is best for back pain, heat or ice? I get conflicting opinions.
Dr_O_Connell: Neither one will hurt – I recommend no longer than 20 minutes on for both. Typically heat is better for muscle spasm and cold for inflammation, but there's no harm in trying one versus the other.
MrsMissy101: Please elaborate on osteopathic manipulative treatment or OMT, what is the basic premise behind this? Thank you!
Dr_O_Connell: OMT is a great way to treat many spinal conditions. The premise is manually manipulating joints in the spine to correct alignment issues. We have Doctors of Osteopathic Medicine (DO) on the spine health team that specializes in this therapy.
saumil0: Instead of implantable stimulators, can Spinal Cord Stimulators (SCS) help to reduce post lower-lumbar surgery back pain?
Dr_O_Connell: Spinal Cord Stimulators do a great job on radicular limb pain, some people respond to back pain as well, but should be considered if more conservative treatments fail.
BarbieV: I read that smoking can worsen back pain, is that true?
Dr_O_Connell: Absolutely! Nicotine restricts blood flow to the spine. Many surgeons will not operate on smokers since the rate of complications is much higher.
GrannyMatt: What do epidural injections do?
Dr_O_Connell: Epidural injections treat pain by relieving inflammation within the spinal canal. They’re best done adjunctive to a therapy program.
jayshree: What are other conservative treatments besides spinal fusion surgery?
Dr_O_Connell: Exercise, injections, medication should all be considered before a fusion.
bill: How do you know when to see a orthopedist or neurosurgeon for severe back pain?
Dr_O_Connell: Typically you would see your primary care doctor or a non-operative spine specialist first who would refer you for surgery. Less than 10% of the patients in our spine center have surgery.
theoneandonlydiggy: Can weight affect lower back pain?
Dr_O_Connell: Yes, we've cancelled surgery on people who have lost weight and no longer require surgical intervention.
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rodgerknowles: Do you have any knowledge on post-polio weakness combined with spinal arthritis? Is there any connection?
Dr_O_Connell: We're learning more and more about post polio patients; it seems that there was a lot more damage from the polio than initially suspected. Many post-polio patients have weakness as they age; this leads to difficulty with muscles that support the spine leading to back pain. I'm not aware if that accelerates arthritis as spinal arthritis is a normal part of aging, but it does contribute to pain.
Naim_Lynn: How serious is a 3.0 bone density loss reading. Is it possible to rebuild bone density once you have been diagnoses with osteoporosis?
Dr_O_Connell: A 3.0 bone density score is considered osteoporosis and should be treated with medication, some medications may increase bone density.
Cleveland_Clinic_Florida_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.
Dr_O_Connell: Thanks for your interest and questions. Sorry if I wasn't able to get to all of them. I had a great time answering them.
Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with John O'Connell, MD is now over. Thank you again, Dr. O'Connell, for taking the time to answer our questions today about Back Pain and Osteoporosis. To make an appointment with Dr. O'Connell, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.
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